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Protecting the Peruvians that need it most !. Comprehensive Health Insurance (SIS). a) Unresolved problems. I. REASON FOR BEING OF THE SIS. Limited access to health services due to the existence of barriers: Economic Cultural Geographic

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slide1

Protecting the Peruvians that need it most !

Comprehensive

Health

Insurance (SIS)

a unresolved problems
a) Unresolved problems

I. REASON FOR BEING OF THE SIS

  • Limited access to health services due to the existence of barriers:
      • Economic
      • Cultural
      • Geographic
  • The existence of barriers requires the development of strategies.
slide3

b) Maternal Mortality (international context)

LOW

Under 20

AVERAGE

20 - 49

HIGH

50 - 149

VERY HIGH

150 or more

Canada

USA

Uruguay

Chile

Argentina

Mexico

Costa Rica

Cuba

Brazil

Colombia

Jamaica

Panama

Dominican Rep.

Trinidad & Tobago

Venezuela

PERU (163)*

(Years 2000,2001)

Bolivia

Guatemala

Haiti

Honduras

Ecuador

El Salvador

Nicaragua

Paraguay

* Per every 100,000 live births

Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

slide4

c) Concern of the health authorities

Other health indicators

  • Perinatal mortality

23.1 x 1,000 l.b.

  • Infant mortality

47.0 x 1,000 l.b.

  • Under-five child mortality

60.4 x 1,000 l.b.

  • Chronic malnutrition

25.4% in children under 5

  • Prevalent diseases:

(ARI, ADD)

Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

slide6

TOWARD THE UNIVERSALIZATION OF SOCIAL SECURITY IN HEALTH

2005

PUBLIC INSURANCE

2012

UNIVERSAL PUBLIC INSURANCE

2001

FRAGMENTATION

ESSALUD

AAFF & NP facil

62.47%

ESSALUD

AAFF & NP

50.33%

ESSALUD

AAFF & NP

SIS

49.67%

SIS

SEG (34.62%)

MCH (2.91%)

Population

26,346

Population

27,148

Population

30,766

Affiliates (46.5%)

12,259

Affiliates (55.9%)

15,171

Affiliates(100%)

slide7

SIS COVERAGE WITHIN UNIVERSAL HEALTH CARE

Population of Peru 2005: 27,219

27.04%

Non-poor Peruvians without Social Security

SIS Goal 2006 Contributory Insurance

23.98%

Peruvians with Social Security

7,059

6,527

100

ESSALUD, HSP,

AAFF & NP facilities

13,633

50.6%

Poor Peruvians without Social Security

11,026,607 SIS Affiliations as of Dec – 2005

slide8

MINSA – Ministry of Health

STEWARDSHIP ROLE

PROVIDER ROLE

INSURER ROLE

Contract and pay the health service provider

Provide health services and charge insurance provider

slide9

COMPREHENSIVE HEALTH INSURANCE

What is SIS?

Decentralized Public Institution

Law Nº 27657 – Law of the Ministry of Health

Integrate and contribute to the universal insurance system that guarantees the full exercise of the right to health, motivating a comprehensive model of care with social and cultural adaptation.

Vision

Administer the funds allocated to financing individual health services according to the National Health Policy.

Mission

Contribute to the protection of uninsured Peruvians, through non-contributory comprehensive health insurance.

Purpose

Guarantee health services to the vulnerable population in a situation of extreme poverty or poverty, under the Universal Insurance Policy.

Priority

slide10

SOURCES OF SIS FINANCING

PUBLIC

TREASURY

COOPERATING

INSTITUTIONS

WB, IDB, PASA

and Others

Comprehensive

Health Insurance

SELF-FINANCING

SiSalud, Labor shares,

Municipality, Markets,

Others

FISSAL

Intangible Health

Solidarity Fund

slide11

COMPREHENSIVE

HEALTH

INSURANCE

NON-CONTRIBUTORY

SEMI-CONTRIBUTORY

PLAN A

PLAN B

PLAN G

G1

INDIVIDUAL

AND FAMILY

PLAN C

PLAN D

G2

WORK-RELATED

ACCIDENTS

PLAN E

PLAN F

G3

MUNICIPALITIES

AND OTHERS

slide12

SIS Target Population

Plan B

5 - 17 years

Plan A

0 - 4 years

Plan C

Pregnant Women

Plan E

Targeted Adults

Plan D

Adults in Emergency Situations

slide13

BENEFIT PLANS

Plan A: Children from 0 to 4 years old

Preventive-promotional care for the healthy newborn and by age groups

Recovery care for the sick newborn and for other age groups

Emergency transfers

Burials

Plan B: Children and adolescents from 5 to 17 years old

Recovery care for children and adolescents with pathologies

Emergency transfers

Burials

slide14

BENEFIT PLANS

Plan C: Pregnant women

Preventive-promotional care for pregnant women

Recovery care from pregnancy, including intercurrent pathologies

Emergency transfers

Burials

Plan D: Adults in Emergency Situations

  • Recovery care for adult emergencies
  • Emergency transfers
  • Burials
slide15

BENEFIT PLANS

Plan E: Targeted Adults

E1: Social grassroots organizations, (Leaders of the Glass of Milk – Vaso de Leche, Mother’s Club – Club de Madres, Communal Kitchen – Comedor Popular, and Children’s Homes - Wawa Wasi - programs),Shoe Shiners, Wrongly Accused, Victims of Human Rights violations (considered in the Truth Commission recommendations).

E2: Dispersed and excluded Amazon populations, dispersed and excluded high Andean populations, community health agents, and victims of social violence (including those affected by the voluntary surgical contraception (AQV) interventions and their direct relatives, and the victims of violence that took place during the May 1980 to November 2000 period.

  • Recovery care for adults with pathologies
  • Emergency transfers
  • Mental care according to Group
  • Burials
slide16

BENEFICIARIES OF HEALTH REPARATIONS

Innocent people who were wrongly accused of terrorism-related crimes

Women who are Victims of Forced Sterilizations

Victims and/or Families of Victims of Human Rights Violations

slide17

SEMI-CONTRIBUTORY INSURANCE

Individual and Family: for beneficiaries that don’t have insurance and are not poor, with limited purchasing power (includes Mototaxi drivers)

Preventive care for the individual and the family

Recovery care for the individual and the family

Odontological care for the individual

Emergency transfers (Urban/Rural/National)

Burials

Labor-related Accidents: “To Work in Urban Areas” program (ATU), Municipalities, Regional Governments and Others*

Recovery care as a result of labor-related accidents

Emergency transfers

Rehabilitation

(*) In some cases, includes outside visits for labor-related accidents

component of service related spending
COMPONENT OF SERVICE-RELATED SPENDING

MEDICINES

LAB. ANALYSIS

VARIABLECOSTS

SIS

RADIOGRAPHS

PROCEDURE

LODGING

FOOD

LAUNDRY

FIXED COSTS

MINSA

GENL. SERVICES

SALARIES

slide20

TYPES OF AFFILIATION

Indirect: Apply using FESE*

Direct: Apply without FESE

Indigent

People

PLAN B

People

in Shelters

PLAN A

Wrongly

Accused

PLAN C

PLAN D

Beneficiaries of

Health Reparat.

Victims of

HHRR Viol.

Women in

OSB**

Women Victims

of Forced Ster.

PLAN E

Shoe

Shiners

Excluded and dispersed

populations

* FESE: Socio-Economic Evaluation Sheet

** OSB: Social grassroots organizations

slide21

Requirements for Affiliation to Plan A, B and C:

  • Not have any type of health insurance
  • Apply with Socio-Economic Evaluation Sheet
  • Identification document
  • Affiliate with Health Estab. in their jurisdiction
  • Sign the Affiliation Contract
  • Pay the premium of S/. 1.00
slide22

AFFILIATION STRATEGIES FOR POPULATION GROUPS

Population in state of poverty

Application of targeting instruments.

Children from PRONOEIS and

Wawa Wasis*

Coordination with Ministry of Education - MINEDU and

National Wawa Wasi Program.

Grassroots: Mother’s Club, Communal Kitchen, Glass of Milk

Coordination with Social Organizations and Ministry of Women & Social Development - MIMDES.

Coordination with FENTRALUC**

to guarantee their affiliation.

Shoe Shiners and

partners

*PRONOEIS: Non-formal early education programs; Wawa Wasis: Children’s Homes

** FENTRALUC: National Federation of Shoe Shine Workers

slide23

AFFILIATION STRATEGIES FOR POPULATION GROUPS

Disabled Children and Adolescents

Preferential Affiliation Campaigns with special schools in Lima and Callao.

Excluded and Dispersed Pop. High Andes, Amazon

Coordination with DISAs – DGSP, AISPED – ODSIS teams.*

Children that suffer from violence and abuse

Extension of MAMIS at the national level, central coordination by DGSP, DGP, UNICEF.**

Older Adults (*)

Coordination with public institutions for inscription enrollment and future affiliation. Law Num. 2858.

Adolescents, Pregnant and Puerperal Women

Coordination with the National Sexual and Reproductive Health Strategy

*DISA: Health Directorate; DGSP: General Public Health Directorate; AISPED: Integral Health Care for Excluded and Dispersed Populations; ODSIS: Decentralized Office of the Comprehensive Health Insurance ** MAMI: Child Abuse Care Module; DGP – General Police Directorate

slide26

PERCENT VARIATION IN CARE, BY TYPE OF CARE 2002 - 2005

Source: Office of Information and Statistics

slide27

VARIATION IN CONCENTRATION BY TYPE OF PLAN 2002 - 2005

Source: Office of Information and Statistics

slide30

Maternal Mortality in the 10 departments with the highest level of deaths. Peru 2000-2004

Source: General Epidemiology Office - OGE - MINSA

slide31

MATERNAL DEATHS BY SPECIFIC CAUSE. PERU 2004

ABORTION

INFECTION

HYPERTENSION

HEMORRHAGE

Source: OGE - MINSA

slide32

MATERNAL DEATHS BY TIME OF DEATH. PERU 2004

UNSPECIFIED

PREGNANCY

PUERPERIUM

ABORTION

DELIVERY

Source: OGE - MINSA

slide33

MATERNAL DEATHS BY PLACE OF DEATH. PERU 2004

IN TRANSIT

UNSPECIFIED

AT HOME

ESTABLISHMENT

Source: OGE - MINSA

slide34

MATERNAL DEATHS BY AGE GROUPS. PERU 2004

35-49 YEARS OLD

UNSPECIFIED

14-19 YEARS OLD

20-34 YEARS OLD

Source: OGE - MINSA

which is why
Which is why…

PROVIDING HEALTH IS NOT A PROBLEM

OF FINANCING ALONE

Finance services in

a timely manner

US (SIS)

Provide quality

services

PROVIDERS

THEM

(beneficiarypopulation)

Exercise their right as citizens

slide36

PROMOTING THE

EXERCISE OF

THE RIGHT

TO HEALTH

THANK YOU